Comparison of safety and efficacy of thoracic epidural block and erector spinae plane block for analgesia in patients with multiple rib fractures: A pilot single-blinded, randomised controlled trial

Background and Aims: Pain associated with rib fractures is challenging to manage. This pilot trial aimed to assess the efficacy of erector spinae plane block (ESPB) compared with thoracic epidural analgesia (TEA) for controlling pain associated with multiple rib fractures. Methods: This randomised, single-blinded, controlled pilot study was conducted on trauma patients who had three or more rib fractures and had been admitted at a tertiary care centre. The study was conducted after receiving ethical approval and trial registration. Patients were randomised into two groups: TEA and ESPB, from February 2019 to February 2020. In the ESPB group, a unilateral or bilateral catheter was inserted in the erector spinae space, and an infusion of 0.125% bupivacaine was started. In the TEA group, the thoracic epidural catheter was inserted, and 0.125% bupivacaine infusion was started. Rescue analgesia using intravenous morphine (0.1 mg/kg) was administered if the Visual Analogue Scale (VAS) score was >3 for 48 hours postoperatively. The primary endpoint was total morphine consumption after administration of ESPB and TEA in patients with a rib fracture. Results: Forty patients completed the study, with 20 in each group. Total morphine consumption by patients in the ESPB group was 5.38 +/- 2.6 mg per 48 hours, and by those in the TEA group was 5.22 +/- 2.11 mg per 48 hours (P = 0.883). Thirty minutes after starting the infusion, mean arterial pressure (MAP) was 64.8 +/- 2.1 mmHg in the ESPB group and 57.2 +/- 1.3 mmHg in the TEA group (P = 0.00001). Conclusion: Total morphine consumption was not statistically different in this pilot trial among the two groups. ESP block may provide similar analgesia with better haemodynamic stability compared to TEA in patients with multiple traumatic rib fractures.